Maternal Mental Health (Postpartum Mental Health)
Introduction
Maternal mental health (MMH) conditions are the most common birth complication, with 1 in 5 people being impacted each year (source). Despite the prevalence, many of those people impacted by MMH conditions remain untreated, increasing the likelihood of negative impacts on the birthing parent and their family (source). These conditions are also the leading cause of maternal mortality at 22% of pregnancy-related deaths (source/source).
Typically when people talk about maternal mental health, they are referring to postpartum depression (PPD). However, there are many MMH conditions that occur during and after pregnancy. Prevalency of MMH conditions in pregnant/postpartum people are as follows:
85% experience periods of emotional sensitivity, feelings of overwhelm, which is often associated with changes in hormones in the immediate postpartum period
14% experience depression, which can include distressing intrusive thoughts, changes in
9% experience PTSD, which can be related to birth trauma (but is not always the cause)
To learn more about birth trauma, click here.
6-8% experience anxiety disorders, which can involve distressing intrusive thoughts, fear of going outside, sleep disturbances and more
4% experience OCD, which can involve “disturbing, repetitive thoughts of harming oneself or baby and cause the individual great distress
3% experience bipolar disorder, which can cause shifts in mood, energy, activity levels, and ability to carry out tasks. Furthermore, those with bipolar disorder are “extremely vulnerable” to recurrence of bipolar symptoms during pregnancy and “have an increased risk for postpartum depression and psychosis.”
1-2 per every 1,000 births experience psychosis. Though it is the least frequently occurring MMH condition, it is the most significant and increases the risk of suicide/infanticide. Psychosis has a sudden onset of 1-2 weeks following childbirth.
To learn more about pregnancy and postpartum psychosis, click here.
Substance use disorder (SUD) is often a comorbid condition, meaning it can develop due to the existence of other conditions. Pregnant people are at the highest risk for SUD during their reproductive years, especially when access to mental health services is limited.
Note: Those who can quit on their own usually do so, which is the distinguishing factor between substance use and SUD.
Causes of MMH Conditions
Causes for MMH Conditions involve a combination of biological,psychological, and societal factors. Biologically, hormones play a big role. After delivery, there is a rapid drop in estrogen and progesterone that has the potential to cause a depressive episode since these hormones are helpful for mood regulation and anxiety (source).
Psychologically, life stressors have also shown to be a factor. Some pregnant people experience “acute highly stressful events” or "chronic levels of stress” caused by factors such as a death in the family, job insecurity, and relationship challenges (source). MHA National has also found “loneliness, and poor self-image/body image also contribute to PPD symptoms.”
At a societal level, certain demographics are at a greater risk for MMH conditions. MHA National reports:
“ages 11-24 were the most at-risk age group for PPD. Parents from the LGBTQ+ community, especially transgender and non-binary individuals, are also at a higher risk for PPD. Multiracial and Indigenous communities are the racial/ethnic groups most at risk. Trauma survivors and parents with a lower household income are also more likely to experience PPD.” (source).
Maternal Mental Health Leadership Alliance (MMHLA) also reported these high risk groups: “people of color, those impacted by poverty, military service members, and military spouses” (source).
Birth Trauma
Birth trauma is another factor. Also called a traumatic childbirth experience, birth trauma “refers to the birthing person’s experiences of interactions and/or events directly related to childbirth that cause overwhelming and distressing emotions, leading to short- and/or long-term negative impacts on the birthing person’s health, wellbeing, and relationships” (source). 1 out of every 3 people reported “feeling traumatized by their childbirth experience” (source) and 1 out of 5 people reported “experiencing some form of mistreatment during pregnancy or childbirth” (source).
According to MMHLA, a leading contribution to birth trauma is the patient’s “perception or experience of poor interpersonal care and/or communication.” They also report that “Women of color are at increased risk for both poor interpersonal care and obstetric complications, increasing their risk for experiencing birth trauma.”
It is important to note that trauma can even occur in situations that providers deem to be “routine” (source). Occurrences of trauma are determined by the perception of the individual who experienced it. This means that a given situation can lead to a traumatic experience for someone, even when it is not considered traumatic for someone else. Trauma occurs when the body’s nervous system is activated into fight-flight-freeze and is distressing to the individual experiencing it. Because of this, birth trauma can lead to many different mental health conditions, including PTSD.
Read more about birth trauma here.
Treatment Barriers & What Happens when MMH Conditions are Left Untreated
Despite how common MMH conditions are, up to 50% of cases go un-diagnosed because of “stigma surrounding the condition and patients' reluctance to disclose symptoms” (source). Lack of access to “critical resources and safe environments” (source) is also a contributor. Medical professionals are an important piece to identifying and treating occurrences of MMH conditions. Without this intervention, patient outcomes can be severely impacted.
When left untreated, MMH conditions can have long term impacts for the whole family. During pregnancy, the birthing parent is more likely to have poor prenatal care, use substances (alcohol, tobacco, and other drugs), experience emotional, physical, or sexual abuse source). During the postpartum period, the birthing parent is more likely to be less responsive to the baby’s cues, have fewer positive interactions with the baby, experience breastfeeding challenges, and question their competency as a parent (source).
Infants born to someone with an untreated MMH condition are at a higher risk for preterm birth, small gestational size, low birth weight, still birth, longer stays in the neonatal intensive care unit, and excessive crying (source).
Signs & Symptoms
Mental health conditions broadly have the ability to change how someone thinks and behaves, even before they realize the change themselves. This is especially true for MMH conditions. According to Atrium Health, if you find any of the following statements to be true for yourself or a loved one, it may be worth talking to your doctor or connecting with a mental health professional:
Is it difficult for you to enjoy yourself?
Are you more irritable or tense?
Are you worried, panicky or sad?
Do you feel as if you are “out of control” or “going crazy?”
Are you having difficulty bonding with your baby?
Have you had thoughts of hurting yourself or your baby?
Common symptoms of MMH conditions include:
Feeling like nothing holds your interest
Feeling lonely, like no one understands
Feeling like a bad parent
Feeling hopeless or overwhelmed
Excessive anxiety about the child’s health
Difficulty bonding with the baby
Sadness and crying
Guilt
Fatigue
Trouble sleeping
Changes in appetite
Poor focus and concentration
Excessive worry
Scary or intrusive thoughts
Confusion
Anger
Thoughts about harming yourself or someone else
According to MHA National, “Symptoms of PPD must be present for more than two weeks following childbirth to distinguish them from postpartum blues” (source)
Resources
To schedule a consultation, call 704-801-9200
Need help now? Call the mental health help line at 704-444-2400
PSI Helpline: 1-800-944-4773
#1 en Español
#2 for English
Text “Help” to 800-944-4773 (EN) | Text en Español: 971-203-7773
Download “Connect PSI from your app store - Access to PSI support, resources and information in the palm of your hand. Download “Connect by PSI” in your app store.
Call or Text 1-833-852-6262
In English and Spanish
TTY users can use a preferred relay service or dial 711 and then 1-833-852-6262
More Reading
Parent Perspectives: Part 1 – Considerations for Changing the NICU Cultures (2023)
Parent Perspectives: Part 2 – Considerations for the Transition Home Post-NICU Discharge (2023)
Perinatal Depression (2025)
Pregnancy and Postpartum Disorders | MHA National
